May, 12, 2023

Sequencing Communications to Encourage Coverage Transitions

Julie Bataille and Kevin Caudill, GMMB

The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act. As a result of the Medicaid renewal process, which resumed in April of 2023, it is expected that millions of people across the country will lose Medicaid [and in some cases, the Children’s Health Insurance Program (CHIP)] coverage. This presents State-Based Marketplaces (SBMs) with an opportunity to target outreach efforts to those audiences who have recently lost Medicaid or CHIP to help eligible individuals retain access to affordable healthcare through the Marketplace. This expert perspective focuses on best practices for timing and strategy in consumer outreach to consumers that are no longer eligible for Medicaid to help states develop a consumer “chase campaign” and is a follow-up to an earlier expert perspective, State Strategies for Sequencing Enrollee Communications When Medicaid Continuous Coverage Ends, which focused on communications to consumers when unwinding began.

Coordination and Sequencing of Communications

While the account transfer process and timing vary by state depending on available data sources and coordination of eligibility and enrollment systems, targeted communications—when paired with any state’s account transfer process—can help consumers maintain or transition to another source of coverage. When state Medicaid agencies determine enrollees ineligible for Medicaid/CHIP, they must determine potential eligibility for other insurance affordability programs and transfer electronic accounts to appropriate programs timely. This includes transferring account data to the Marketplace, which enables a Marketplace to conduct direct outreach to, or “chase,” those consumers. When a consumer loses Medicaid/CHIP, they will qualify for a special enrollment period (SEP) if they report their loss of Medicaid/CHIP within 60 days before or after they lost coverage. The Centers for Medicare & Medicaid Services (CMS) is encouraging SBMs to adopt SEP flexibilities, including the new “Unwinding SEP” available to individuals who attest to losing Medicaid/CHIP anytime between March 31, 2023, and July 31, 2024, provided they submit a new Marketplace application or update an existing one.

As chase campaigns are planned, it is important to maximize the use of SEP timeframes to prevent consumers from experiencing gaps in health coverage. States can use multiple direct touchpoints, after account transfer data is available, to let consumers know specific coverage options that exist for them and the timing to enroll in a plan after Medicaid/CHIP termination. Using direct communications modalities complements larger outreach and education efforts and enables agencies to reinforce important messages and drive consumer behavior at the key moments they will need to take action to keep coverage. Coordinating across agencies is also important to prevent consumer confusion and reinforce the availability of trusted resources. For example, Medicaid notices and follow-up requests for information should include Marketplace information, including cobranded logos, as one way to help consumers be aware of and expect to hear from the Marketplace as well as legitimize coverage sources that may otherwise be less familiar.

As part of an integrated public education effort, states will leverage multiple channels to share information and resources. A targeted chase campaign including direct mail, email, phone calls, and text messages, can reinforce important messages and help to reach consumers multiple times through a variety of touchpoints and trusted sources of information. SBMs can also consider leveraging their contracted assisters to provide coordinated messaging and direct outreach and enrollment assistance to consumers.

CMS is implementing a robust outreach strategy in the Federally-Facilitated Marketplace (FFM) to raise awareness of and low-cost coverage options that may be available to individuals in FFM states who are no longer eligible for Medicaid. When receives inbound account transfer information from states it begins its direct-to-consumer outreach process. Consumers will receive multi-pronged communications to remind them what steps they need to take, where to get help, the availability of an SEP, and deadlines to enroll to keep health coverage. This will include an initial notice (sample here); email, text, and phone call outreach; reminder letters (samples here) for consumers who do not secure coverage after the first month; and direct assister outreach. The graphic below depicts the planned outreach. CMS will refine data as time goes on to try to narrow outreach, particularly direct assister outreach, to reach consumers who have not secured other coverage.

CMS will be matching consumers who have not secured coverage after the first month or so with FFM assisters in their area. Most reminder letters will include the assister organization name to which the consumer’s household was matched, along with specific contact information for that assister organization. Matching consumers with assisters in their local area will ensure that they can access in-person help, if desired, and ensure they are able to interface with assisters who best understand their community and the coverage options available.  

Assisters will use a secure platform to access and manage consumer assignments from the Marketplace. Only assister organizations that are directly contracted with the FFM will receive outreach assignments. Assisters will use a host of communication and engagement methods to reach assigned consumers, including but not limited to phone calls, emails, and text messages, and will provide education, outreach, and enrollment services in a manner that is culturally and linguistically appropriate to the needs of communities served, including individuals with limited English proficiency.

What Will Marketplace Consumer Communications Look Like?

Source: Centers for Medicare & Medicaid Services

The following illustration highlights a potential cadence for direct consumer outreach that states should customize based on their SEPs, partners, data flow, and system capacity. Note that each state’s cadence will also depend on how frequently they can update data to know when Medicaid terminations occur, when Marketplace applications begin, and when enrollments take place so that messaging and frequency of communications can be calibrated accordingly and remain focused on getting consumers to complete their enrollment journey to avoid a gap in health coverage.

Illustrative Outreach Timeline Example

Message Recommendations

The multi-pronged communications strategy taken by CMS can also be utilized by states to reduce coverage gaps by highlighting for consumers when they need to complete a health insurance Marketplace application. The messages in direct-to-consumer communications from states can become more tailored to the individual as audiences are segmented based on available data and where they are in the process. The sequence of messages and cadence will vary according to individual enrollment deadlines.

Research shows that there is a lack of awareness of Marketplaces and the availability of financial help. It is critical that chase campaigns address these knowledge gaps head-on. Direct-to-consumer messaging should:

  • Introduce the official Marketplace in your state  
  • Describe the availability of financial help and the low cost of plans
  • Emphasize the deadline to enroll and the need to begin or complete a Marketplace application to avoid a gap in coverage
  • Reinforce the availability of consumer assistance


SHVS has created template outreach resources available for states in multiple languages, including social graphics and sample messages, an unwinding message guide, as well as text messages for renewals.


The potential churn created by Medicaid/CHIP disenrollment presents states with an opportunity to conduct outreach to those determined ineligible to inform them of their options for alternate insurance on the individual Marketplace, and ensure they retain access to affordable healthcare coverage. States can augment their outreach and education efforts with direct-to-consumer communications as part of their overall strategy to maximize coverage.